|
INSERT TS TIBIAL #7/12MM
|
Facility
|
IP
|
$7,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
INSERT TS TIBIAL #7/12MM
|
Facility
|
OP
|
$7,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem Medicaid |
$2,544.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Humana KY Medicaid |
$2,544.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,570.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,595.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
INSERT TS TIBIAL #7/12MM 5T
|
Facility
|
OP
|
$7,860.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.85 |
| Max. Negotiated Rate |
$7,545.95 |
| Rate for Payer: Aetna Commercial |
$6,052.48
|
| Rate for Payer: Anthem Medicaid |
$2,703.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.08
|
| Rate for Payer: Cash Price |
$3,930.18
|
| Rate for Payer: Cigna Commercial |
$6,524.10
|
| Rate for Payer: First Health Commercial |
$7,467.34
|
| Rate for Payer: Humana Commercial |
$6,681.31
|
| Rate for Payer: Humana KY Medicaid |
$2,703.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,800.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,358.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,757.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.71
|
| Rate for Payer: PHCS Commercial |
$7,545.95
|
| Rate for Payer: United Healthcare All Payer |
$6,917.12
|
|
|
INSERT TS TIBIAL #7/12MM 5T
|
Facility
|
IP
|
$7,860.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.85 |
| Max. Negotiated Rate |
$7,545.95 |
| Rate for Payer: Aetna Commercial |
$6,052.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.08
|
| Rate for Payer: Cash Price |
$3,930.18
|
| Rate for Payer: Cigna Commercial |
$6,524.10
|
| Rate for Payer: First Health Commercial |
$7,467.34
|
| Rate for Payer: Humana Commercial |
$6,681.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,800.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,358.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.71
|
| Rate for Payer: PHCS Commercial |
$7,545.95
|
| Rate for Payer: United Healthcare All Payer |
$6,917.12
|
|
|
INSERT TS TIBIAL #7/14MM
|
Facility
|
IP
|
$7,860.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.85 |
| Max. Negotiated Rate |
$7,545.95 |
| Rate for Payer: Aetna Commercial |
$6,052.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.08
|
| Rate for Payer: Cash Price |
$3,930.18
|
| Rate for Payer: Cigna Commercial |
$6,524.10
|
| Rate for Payer: First Health Commercial |
$7,467.34
|
| Rate for Payer: Humana Commercial |
$6,681.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,800.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,358.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.71
|
| Rate for Payer: PHCS Commercial |
$7,545.95
|
| Rate for Payer: United Healthcare All Payer |
$6,917.12
|
|
|
INSERT TS TIBIAL #7/14MM
|
Facility
|
OP
|
$7,860.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.85 |
| Max. Negotiated Rate |
$7,545.95 |
| Rate for Payer: Aetna Commercial |
$6,052.48
|
| Rate for Payer: Anthem Medicaid |
$2,703.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.08
|
| Rate for Payer: Cash Price |
$3,930.18
|
| Rate for Payer: Cigna Commercial |
$6,524.10
|
| Rate for Payer: First Health Commercial |
$7,467.34
|
| Rate for Payer: Humana Commercial |
$6,681.31
|
| Rate for Payer: Humana KY Medicaid |
$2,703.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,800.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,358.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,757.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.71
|
| Rate for Payer: PHCS Commercial |
$7,545.95
|
| Rate for Payer: United Healthcare All Payer |
$6,917.12
|
|
|
INSERT TS TIBIAL #7/14MM 5T
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #7/14MM 5T
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #7/16MM
|
Facility
|
OP
|
$8,485.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.08 |
| Max. Negotiated Rate |
$8,145.83 |
| Rate for Payer: Aetna Commercial |
$6,533.63
|
| Rate for Payer: Anthem Medicaid |
$2,918.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.49
|
| Rate for Payer: Cash Price |
$4,242.62
|
| Rate for Payer: Cigna Commercial |
$7,042.75
|
| Rate for Payer: First Health Commercial |
$8,060.98
|
| Rate for Payer: Humana Commercial |
$7,212.45
|
| Rate for Payer: Humana KY Medicaid |
$2,918.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,957.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,363.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,697.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,103.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,630.42
|
| Rate for Payer: PHCS Commercial |
$8,145.83
|
| Rate for Payer: United Healthcare All Payer |
$7,467.01
|
|
|
INSERT TS TIBIAL #7/16MM
|
Facility
|
IP
|
$8,485.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.08 |
| Max. Negotiated Rate |
$8,145.83 |
| Rate for Payer: Aetna Commercial |
$6,533.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,618.49
|
| Rate for Payer: Cash Price |
$4,242.62
|
| Rate for Payer: Cigna Commercial |
$7,042.75
|
| Rate for Payer: First Health Commercial |
$8,060.98
|
| Rate for Payer: Humana Commercial |
$7,212.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,957.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,363.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,697.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,103.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,630.42
|
| Rate for Payer: PHCS Commercial |
$8,145.83
|
| Rate for Payer: United Healthcare All Payer |
$7,467.01
|
|
|
INSERT TS TIBIAL #7/16MM 5T
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #7/16MM 5T
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #7/18MM
|
Facility
|
IP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #7/18MM
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
|
INSERT TS TIBIAL #7/18MM 5T
|
Facility
|
OP
|
$8,164.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.33 |
| Max. Negotiated Rate |
$7,837.48 |
| Rate for Payer: Aetna Commercial |
$6,286.31
|
| Rate for Payer: Anthem Medicaid |
$2,807.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,367.95
|
| Rate for Payer: Cash Price |
$4,082.02
|
| Rate for Payer: Cigna Commercial |
$6,776.15
|
| Rate for Payer: First Health Commercial |
$7,755.84
|
| Rate for Payer: Humana Commercial |
$6,939.43
|
| Rate for Payer: Humana KY Medicaid |
$2,807.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,694.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,025.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,863.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,184.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,123.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.85
|
| Rate for Payer: PHCS Commercial |
$7,837.48
|
| Rate for Payer: United Healthcare All Payer |
$7,184.36
|
|
|
INSERT TS TIBIAL #7/18MM 5T
|
Facility
|
IP
|
$8,164.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.33 |
| Max. Negotiated Rate |
$7,837.48 |
| Rate for Payer: Aetna Commercial |
$6,286.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,367.95
|
| Rate for Payer: Cash Price |
$4,082.02
|
| Rate for Payer: Cigna Commercial |
$6,776.15
|
| Rate for Payer: First Health Commercial |
$7,755.84
|
| Rate for Payer: Humana Commercial |
$6,939.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,694.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,025.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,184.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,123.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.85
|
| Rate for Payer: PHCS Commercial |
$7,837.48
|
| Rate for Payer: United Healthcare All Payer |
$7,184.36
|
|
|
INSERT TS TIBIAL #7/21MM
|
Facility
|
IP
|
$8,321.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.82 |
| Max. Negotiated Rate |
$7,988.85 |
| Rate for Payer: Aetna Commercial |
$6,407.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.94
|
| Rate for Payer: Cash Price |
$4,160.86
|
| Rate for Payer: Cigna Commercial |
$6,907.03
|
| Rate for Payer: First Health Commercial |
$7,905.63
|
| Rate for Payer: Humana Commercial |
$7,073.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,579.73
|
| Rate for Payer: PHCS Commercial |
$7,988.85
|
| Rate for Payer: United Healthcare All Payer |
$7,323.11
|
|
|
INSERT TS TIBIAL #7/21MM
|
Facility
|
OP
|
$8,321.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.82 |
| Max. Negotiated Rate |
$7,988.85 |
| Rate for Payer: Aetna Commercial |
$6,407.72
|
| Rate for Payer: Anthem Medicaid |
$2,861.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.94
|
| Rate for Payer: Cash Price |
$4,160.86
|
| Rate for Payer: Cigna Commercial |
$6,907.03
|
| Rate for Payer: First Health Commercial |
$7,905.63
|
| Rate for Payer: Humana Commercial |
$7,073.46
|
| Rate for Payer: Humana KY Medicaid |
$2,861.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,579.73
|
| Rate for Payer: PHCS Commercial |
$7,988.85
|
| Rate for Payer: United Healthcare All Payer |
$7,323.11
|
|
|
INSERT TS TIBIAL #7/21MM 5T
|
Facility
|
OP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem Medicaid |
$2,416.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Humana KY Medicaid |
$2,416.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #7/21MM 5T
|
Facility
|
IP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #7/24MM
|
Facility
|
OP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem Medicaid |
$2,416.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Humana KY Medicaid |
$2,416.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #7/24MM
|
Facility
|
IP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #7/24MM 5T
|
Facility
|
IP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #7/24MM 5T
|
Facility
|
OP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem Medicaid |
$2,416.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Humana KY Medicaid |
$2,416.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #9/10MM
|
Facility
|
OP
|
$6,905.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$6,629.30 |
| Rate for Payer: Aetna Commercial |
$5,317.25
|
| Rate for Payer: Anthem Medicaid |
$2,374.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.31
|
| Rate for Payer: Cash Price |
$3,452.76
|
| Rate for Payer: Cigna Commercial |
$5,731.58
|
| Rate for Payer: First Health Commercial |
$6,560.24
|
| Rate for Payer: Humana Commercial |
$5,869.69
|
| Rate for Payer: Humana KY Medicaid |
$2,374.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.71
|
| Rate for Payer: PHCS Commercial |
$6,629.30
|
| Rate for Payer: United Healthcare All Payer |
$6,076.86
|
|
